Talar Revascularization After a Complete Talar Extrusion

Gerken, Nicholas; Yalamanchili, Raj; Yalamanchili, Sandeep; Penagaluru, Pranay; Milman, Edward; Cox, Garrick

doi:10.1097/bot.0b013e318210f236

Cited by 23 publications

(14 citation statements)

References 13 publications

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“…However, subsequent sporadic reports of favorable outcomes with reimplantation led to the exploration of reimplantation as a first-line treatment [7]. Gerken, et al had suggested that with immediate reimplantation and follow up care, AVN should be delayed as long as possible [29]. Kwak, et al reported revascularisation of a completely extruded talus with serial MRI scans after prompt reimplantation.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2019

J Musculoskelet Disord Treat

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Section: Discussionmentioning

confidence: 99%

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2019

J Musculoskelet Disord Treat

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“…In addition, the functional outcomes of patients managed by primary talectomy were worse than those of the group as a whole, none of the former cases achieving a good outcome. Many of the reviewed articles recommended attempting to preserve the talus, even in cases of total extrusion with significant contamination, preservation having a better chance for a good outcome and a similar risk of complications 3,[31][32][33][34][35][36][37][38] .…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Total Dislocation of the Talus

Weston

Liu

Wandtke

et al. 2015

Orthopaedic Surgery

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This review summarizes the treatment and resulting outcomes for total talar dislocation. The PubMed database was searched for articles about humans with total talar dislocation published in the English language in the last twenty years. The following data were entered into a Microsoft Excel spreadsheet: type of dislocation, nature of associated fractures (if any), type of reduction/fixation utilized, immobilization, weight-bearing status, outcome, complications and average follow-up time. Thirty-nine articles reporting a total of 86 cases of total talar dislocation are included in this review. Seventy-three of these were open injuries and 13 closed. Forty-three cases had an associated foot or ankle fracture, 32 of those cases specifically having a fracture of the talus. The talus was preserved in the initial management of 74 cases, whereas the remaining 12 cases were managed by primary talectomy. The mean duration of follow-up was 32 months. Twenty-two cases required a secondary arthrodesis or another additional procedure. A good outcome was achieved in 35% of cases, a fair outcome in 37% and a poor outcome in 27%. The complication of avascular necrosis (AVN) occurred in 22 cases and 14 subjects developed clinically significant osteoarthritis. Generally, the outcome of current treatments associated with total talar dislocation is not ideal, only 1/3 of cases achieving good outcomes. So far, preservation of the talus is the best treatment option. AVN is still a relatively common complication even in the absence of fracture or postoperative infection.

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“…Our case adds to the growing evidence that prompt reduction and correct soft tissue management of open total talar dislocation is not necessarily associated with high rates of infection. 1,9 AVN is another problem after talar reimplantation. Although it can take longer than two years to appear on imaging studies, most cases of post-traumatic osteonecrosis manifest within the first 10 months after injury.…”

Section: Discussionmentioning

confidence: 99%

“…10 Magnetic resonance imaging is the most sensitive test available to determine the presence and extent of AVN. 3,9 But this method is not routinely used to diagnose or follow osteonecrosis even in recent series 1,6 since it is not a cost effective screening tool. AVN was not observed at final follow-up in our patient.…”

Section: Discussionmentioning

confidence: 99%

Delayed debridement of an open total talar dislocation reimplanted in the emergency room

Sié

Traoré

et al. 2014

Journal of Clinical Orthopaedics and Trauma

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Open total talar dislocation is a rare but well known injury. Its management is controversial and fraught with complications such as infection, avascular necrosis, and post-traumatic osteoarthritis. We report the case of a woman sustaining a pure open talar dislocation reduced in the emergency room. Debridement was done three days after the injury in the operating room. There was no infection. One year after surgery she complained of occasional pain. Ambulation was normal. She wore regular shoes. The overall alignment of the ankle, hindfoot, and midfoot was normal. Movements of the tibiotalar and subtalar joints were not impaired. She has resumed her regular activities. Radiographs showed no signs of avascular necrosis. All components of the treatment strategy of open total dislocation should be carried out in emergency. This results in environment close to the original biological state. Good results can be achieved if infection is avoided.

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Talar Revascularization After a Complete Talar Extrusion

Cited by 23 publications

References 13 publications

Untitled

Untitled

A Systematic Review of Total Dislocation of the Talus

Delayed debridement of an open total talar dislocation reimplanted in the emergency room

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